Always make recommendations by determining needed vaccines based on age (Table 1), assessing for medical conditions and other indications (Table 2), and reviewing special situations (Notes).

Vaccines in the Adult Immunization Schedule

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Legend

Recommended vaccination for adults who meet age requirement, lack documentation of vaccination, or lack evidence of past infection

Recommended vaccination for adults with an additional risk factor or another indication

Precaution—vaccination might be indicated if benefit of protection outweighs risk of adverse reaction

Delay vaccination until after pregnancy if vaccine is indicated

No recommendation/ Not applicable

adult conditions vaccine schedule

Vaccine

Pregnancy

Immuno-compromised (excluding HIV infection)

HIV infection CD4 count

Asplenia, complement deficiencies

End-stage renal disease; or on hemodialysis

Heart or lung disease, alcoholism 1

Chronic liver disease

Diabetes

Health care personnel 2

Men who have sex with men

1 dose annually

Tdap or Td

1 dose Tdap each pregnancy

1 dose Tdap, then Td or Tdap booster every 10 yrs

MMR

NOT RECOMMENDED

1 or 2 doses depending on indication

VAR

NOT RECOMMENDED

2 doses

RZV(preferred)

DELAY

2 doses at age ≥50 yrs

ZVL

NOT RECOMMENDED

1 dose at age ≥60 yrs

HPV

DELAY

3 doses through age 26 yrs

2 or 3 doses through age 26 yrs

PCV13

1

dose

PPSV23

1, 2,or 3 doses depending on age

and indication

HepA

2 or 3

doses

depending on vaccine

HepB

2 or 3

doses depending on vaccine

MenACWY

1 or 2 doses

depending on indication,

see notes for booster recommendations

MenB

PRECAUTION

2 or 3 doses

depending on

vaccine and indication, see notes for booster recommendations

Hib

3 doses HSCT 3 recipients only

1

dose

Administer recommended vaccines if vaccination history is incomplete or unknown. Do not restart or add doses to vaccine series if there are extended intervals between doses. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Notes

Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2020

For vaccine recommendations for persons age 0 through 18 years, see the Child and Adolescent Immunization Schedule.

Work with hepatitis A virus in research laboratory or with nonhuman primates with hepatitis A virus infection

Travel in countries with high or intermediate endemic hepatitis A

Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A (administer dose 1 as soon as adoption is planned, at least 2 weeks before adoptee’s arrival)

Pregnancy if at risk for infection or severe outcome from infection during pregnancy

Settings for exposure, including health care settings targeting services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons (individual risk factor screening not required)

Hepatitis B vaccination

Routine vaccination

Not at risk but want protection from hepatitis B (identification of risk factor not required): 2- or 3-dose series (2-dose series Heplisav-B at least 4 weeks apart [2-dose series HepB only applies when 2 doses of Heplisav-B are used at least 4 weeks apart] or 3-dose series Engerix-B or Recombivax HB at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 8 weeks between doses 2 and 3, 16 weeks between doses 1 and 3]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])

Special situations

At risk for hepatitis B virus infection: 2-dose (Heplisav-B) or 3-dose (Engerix-B, Recombivax HB) series or 3-dose series HepA-HepB (Twinrix) as above

Percutaneous or mucosal risk for exposure to blood (e.g., household contacts of HBsAg-positive persons; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; persons with diabetes mellitus age younger than 60 years and, at discretion of treating clinician, those age 60 years or older)

Incarcerated persons

Travel in countries with high or intermediate endemic hepatitis B

Pregnancy if at risk for infection or severe outcome from infection during pregnancy. Heplisav-B not currently recommended due to lack of safety data in pregnant women

Human papillomavirus vaccination

Routine vaccination

HPV vaccination recommended for all adults through age 26 years: 2- or 3-dose series depending on age at initial vaccination or condition:

Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2, 6 months (minimum intervals: 4 weeks between doses 1 and 2/12 weeks between doses 2 and 3/5 months between doses 1 and 3; repeat dose if administered too soon)

Age 9 through 14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart: 1 dose

Age 9 through 14 years at initial vaccination and received 2 doses at least 5 months apart: HPV vaccination complete, no additional dose needed.

If completed valid vaccination series with any HPV vaccine, no additional doses needed

Shared clinical decision-making

Age 27 through 45 years based on shared clinical decision-making:

2- or 3-dose series as above

Special situations

Pregnancy through age 26 years: HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant; pregnancy testing not needed before vaccination

Influenza vaccination

Routine vaccination

Persons age 6 months or older: 1 dose any influenza vaccine appropriate for age and health status annually

Special situations

Egg allergy more severe than hives (e.g., angioedema, respiratory distress): 1 dose any influenza vaccine appropriate for age and health status annually in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions

LAIVshould not be used in persons with the following conditions or situations:

History of severe allergic reaction to any vaccine component (excluding egg) or to a previous dose of any influenza vaccine

Immunocompromised due to any cause (including medications and HIV infection)

Anatomic or functional asplenia

Cochlear implant

Cerebrospinal fluid-oropharyngeal communication

Close contacts or caregivers of severely immunosuppressed persons who require a protected environment

Pregnancy

Received influenza antiviral medications within the previous 48 hours

History of Guillain-Barré syndrome within 6 weeks of previous dose of influenza vaccine: Generally should not be vaccinated unless vaccination benefits outweigh risks for those at higher risk for severe complications from influenza

Measles, mumps, and rubella vaccination

Routine vaccination

No evidence of immunity to measles, mumps, or rubella: 1 dose

Evidence of immunity: Born before 1957 (health care personnel, see below), documentation of receipt of MMR vaccine, laboratory, laboratory evidence of immunity or disease (diagnosis of disease without laboratory confirmation is not evidence of immunity)

Special situations

Pregnancy with no evidence of immunity to rubella: MMR contraindicated during pregnancy; after pregnancy (before discharge from health care facility), 1 dose

Nonpregnant women of childbearing age with no evidence of immunity to rubella: 1 dose

HIV infection with CD4 count ≥200 cells/μL for at least 6 months and no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart; MMR contraindicated in HIV infection with CD4 count adult vaccine schedule

Vaccines

Abbreviations

Trade names

Haemophilus influenzae type b

Hib

ActHIB ® Hiberix ® PedvaxHIB ®

Hepatitis A vaccine

HepA

Havrix ® Vaqta ®

Hepatitis A and hepatitis B vaccine

HepA-HepB

Twinrix ®

Hepatitis B vaccine

HepB

Engerix-B ® Recombivax HB ® Heplisav-B ®

Human papillomavirus vaccine

HPV vaccine

Gardasil 9 ®

Influenza vaccine, inactivated

IIV

Many brands

Influenza vaccine, live, attenuated

LAIV

FluMist ® Quadrivalent

Influenza vaccine, recombinant

RIV

Flublok Quadrivalent ®

Measles, mumps, and rubella vaccine

MMR

M-M-R ® II

Meningococcal serogroups A, C, W, Y vaccine

MenACWY

Menactra ® Menveo ®

Meningococcal serogroup B vaccine

MenB-4C MenB-FHbp

Bexsero ® Trumenba ®

Pneumococcal 13-valent conjugate vaccine

PCV13

Prevnar 13 ®

Pneumococcal 23-valent polysaccharide vaccine

PPSV23

Pneumovax ® 23

Tetanus and diphtheria toxoids

Td

Tenivac ® Tdvax™

Tetanus and diphtheria toxoids and acellular pertussis vaccine

Tdap

Adacel ® Boostrix ®

Varicella vaccine

VAR

Varivax ®

Zoster vaccine, recombinant

RZV

Shingrix

Zoster vaccine live

ZVL

Zostavax ®

This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American College of Physicians (ACP external ), American Academy of Family Physicians (AAFP external ), American College of Obstetricians and Gynecologists (ACOG external ), and American College of Nurse-Midwives (ACNM external ).

The comprehensive summary of the ACIP recommended changes made to the adult immunization schedule can be found in the February 6, 2020 MMWR.

Suspected cases of reportable vaccine-preventable diseases or outbreaks to the local or state health department

All vaccines included in the adult immunization schedule except pneumococcal 23-valent polysaccharide and zoster vaccines are covered by the Vaccine Injury Compensation Program. Information on how to file a vaccine injury claim is available at www.hrsa.gov/vaccinecompensation or 800-338-2382.

This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American College of Physicians (ACP external ), American Academy of Family Physicians (AAFP external ), American College of Obstetricians and Gynecologists (ACOG external ), and American College of Nurse-Midwives (ACNM external ).

The comprehensive summary of the ACIP recommended changes made to the adult immunization schedule can be found in the February 6, 2020 MMWR.

www.cdc.gov

Who is shown to be vaccinated against tick-borne encephalitis,contraindications, price, side effects

Update: October 2018

Tick-borne encephalitis is an infectious disease caused by tick-borne encephalitis virus and manifested damage to the central and peripheral nervous system.

It should be understood that an encephalitic tick is not some kind of a certain type of tick (ticks about 30 thousand species, encephalitis can be only 5 thousand), and the tick infected erbovirus causing encephalitis in humans.

Moreover, encephalitis can be infected by using raw milk from cows, sheep, most often goats – because in milk This virus may be contained during a mass tick attack pets.

Symptoms of tick-borne encephalitis

The first symptoms of tick-borne encephalitis develop in 1-2 weeks after the bite and manifestations resemble a cold. These include fever, headache, muscle pain, aching joints. Symptoms persist for a week. After which most patients is recovering.

Approximately every third patient develops more severe encephalitis form, which is accompanied by:

persistent temperature rise to high numbers

unbearable headaches

neck pain

vomiting and lethargy

If such symptoms occur, you must immediately обратиться к to the doctor. In severe cases, encephalitis leads to irreversible damage in the form of paralysis or death of the patient.

Every year around 10-12 thousand are registered in the world. случаев tick-borne encephalitis. Highest frequency incidence is noted in the Baltic countries, Slovenia and Russia. On the territory of the Russian Federation, the incidence is 2.5 per 100 thousand population, but in some endemic areas (north, northwest), this index increases by more than 5 times.

The increasing danger of tick-borne encephalitis is due to the occurrence of incidence cases in areas not previously considered endemic (Scandinavia, Switzerland, Germany).

The source of the virus are more than 100 species of animals, including foxes, voles, deer, dogs, monkeys and horses. Exists probability of tick-borne encephalitis virus penetration infected cows in milk. When used unpasteurized milk infection occurs in humans alimentary way.

The disease is characterized by two periods of increased incidence: May-June and August-September. Immunization of the population It is planned based on the given time frame.

Endemic regions of tick-borne encephalitis are rural areas of Russia, Central and Eastern Europe and Japan. Tick-borne encephalitis vaccination is recommended. residents of these regions, as well as tourists and tourists traveling to these areas the worker. The risk of tick-borne encephalitis increases during high activity of ticks (from April to October).

In these areas, tick-borne encephalitis is serious economic problem due to the need for long treatment of neurological complications. Use of vaccination in countries Europe for ten years allowed to reduce economic losses at 80 million dollars.

Vaccination scheme

Two vaccines are most common in Russia: �”Tick-E-Vac” and “Tick-borne encephalitis vaccine”. This drugs domestic production containing inactivated virus. Vaccination against tick-borne encephalitis with these drugs is not can cause disease. After vaccination, the human body produces specific antibodies to the introduced virus, providing immunization to this type of pathogens.

Exists две схемы иммунизации: двух- и трехкомпонентная. Both provide the production of the required amount of antibodies to virus, but differ in the duration of maintaining their concentration at the required level.

Two component scheme

The first dose of vaccine should be administered in 1-3 months before the start of the season of increased morbidity. Two stage vaccination scheme is as follows:

1-3 months before high risk of tick-borne encephalitis (approximately April);

1-7 months after the first dose.

The best effect is provided by immunization planning. Thus, the second injection was carried out 1 month before intended trip or before the season. Revaccination should be made after 1 year, and then every 5 years. However, according to studies, a sufficient concentration of antibodies in The body persists for 6-8 years.

The vaccine is injected intramuscularly in the upper third of the shoulder. Graft from tick-borne encephalitis may not be effective enough people with congenital or acquired immunodeficiency. To this group include patients undergoing or receiving immunosuppressants (chemotherapy, high doses of corticosteroids, immunosuppressive drugs), patients with HIV / AIDS (see symptoms of HIV infection, AIDS dissidents), with congenital anomalies of immune function system.

Three-part scheme

The introduction of the vaccine in a three-component scheme is in the following way:

Day the first dose is indicated as day “0”;

The second dose is administered 1-3 months after the first;

The introduction of the third dose of the vaccine is carried out in 5-12 months after the second.

Other features of vaccination

Subsequent supportive vaccinations in both cases. produced every three years while maintaining risk factors diseases. If a person changes his place of work or residence, no need for immunization.

Vaccination for children from 3 to 15 years old is made in a reduced dosage – ½ of the adult dose. Vaccine can be administered simultaneously. with other vaccines. Precautions include carrying injecting different vaccines into different places and using different syringes. Maximum immunization is observed one week after the introduction of the second dose.

In this case, the doctor must determine the level of antibodies in the blood. after the introduction of the second dose and decide on the issue additional supportive vaccination. Be sure to put the doctor is informed of the vaccinations received earlier from the Japanese encephalitis, yellow fever or dengue fever. The presence of antibodies to causative agents of these diseases may affect the assessment results of a control immunological study.

Vaccination, carried out after the tick bite, is ineffective. In this case, for the prevention of disease The administration of a specific immunoglobulin is recommended.

Average cost of vaccination

Regarding the cost of vaccination – the cost of a single dose of vaccine is 400-500 rubles for drugs manufactured in Russia and 1000 – 1500 – for foreign ones. It is also worth considering that this is the price. only one vaccination, but it takes 2 or 3 doses of the vaccine according to the scheme. As a rule, special offers are provided in each clinic. and discounts when ordering a collective immunization. Despite the difference in cost, efficacy of domestic and European vaccines stays approximately on the same level.

Indications for vaccination

Who shows tick-borne encephalitis vaccine first of all? Vaccination against tick-borne encephalitis is carried out:

Persons traveling to endemic areas with a humid climate and forest landscape, especially in spring and summer, when tick activity increases;

People who are fond of hiking, hunting and working in areas endemic for the incidence of tick-borne encephalitis;

It is desirable that immunization be completed in more than a month. before the intended departure to the region. In this case, provided reliable protection against all strains of the virus.

Contraindications

Before the start of immunization necessarily taken into account vaccination contraindications:

Confirmed anaphylactic reaction after the previous administering the vaccine or one of its components;

Severe allergies to eggs or chicken meat (anaphylactic reactions);

Allergy to formaldehyde, neomycin, gentamicin and protamine sulfate;

Acute inflammatory diseases (vaccination is delayed until recovery).

Vaccination for children under 1 year is not made. With the development of any allergy manifestations after vaccination be sure to refer to to the doctor.

Pregnancy and breastfeeding are not contraindications. for vaccination, however, be sure to inform the doctor about that you are pregnant or are planning a pregnancy.

There is currently no reliable hit information. vaccine components in breast milk. Put a vaccine nursing mothers are only possible when the intended benefits of immunization will exceed the potential risk to the child.

Some people have increased after the first vaccination. temperature Usually this symptom develops within 12 hours. after an injection and passes independently in 24-48 hours.

The effectiveness of vaccination is 99%. According to statistical data, after the introduction of the practice of vaccination incidence tick-borne encephalitis decreased by 90%.

Side effects

Adverse effects of vaccination in the form of side effects more likely in patients with:

Far from each patient develops the above complications after vaccination. Studies have shown that new forms Vaccines are fairly safe.

At the same time, some side effects have been observed quite often. Transient redness and soreness at the injection site were noted in 45%, and fever – in 5-6%. Symptoms had transient character and did not represent threats to health.

WHO position

Immunization provides the most effective protection against tick-borne encephalitis. Vaccines used in Russia are safe and shown for use by people from the age of three. After their use, a strong immunity develops, providing protection against most types of tick-borne encephalitis virus, characteristic of Asia and Europe.

Before the start of mass immunization in each The region needs a thorough assessment of the number of cases. incidence among the population. With a low risk of morbidity vaccination is considered inappropriate. Consider vaccination is necessary if the incidence in the region is from 5 cases per 100 thousand population.

In areas with increased risk, vaccination should be included in national immunization program. In other cases, vaccination held individually by people planning a trip to endemic area or shift workers.